Physicians, Business, Professional and Information Technology Communities
Networking to Restore Accountability in HealthCare & Medical Practice
Tuesday, March 23, 2004
MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing was introduced in this country with HMOs, under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.
We welcome you to the reestablishment of these MedicalTuesday interchanges, now occurring on the world wide web. If this newsletter has been forwarded to you or you have not been on our email list, please go to www.MedicalTuesday.net and subscribe to continue to receive these free messages on alternate MedicalTuesdays. At this site you can also subscribe to the companion quarterly newsletter, HealthPlanUSA, designed to make HealthCare more affordable for all Americans. Please forward this message to your friends. If you do not wish to receive these messages, we have made it easier for you to unsubscribe simply by clicking the Remove Link below.
In This Issue:
1. Why You Can’t Buy Insurance
2. Health Care Report Cards May Fail Patients. Why Risk Doing More Harm?
3. One Answer to the Uninsured
4. Can Private Medicine and Socialized Medicine Coexist?
5. Medical Gluttony or Excessive HealthCare Costs
6. Overheard in the Medical Staff Lounge
7. The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government
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1. Why You Can’t Buy Insurance
The press corps plays up the annual census bureau figures showing how the number of Americans without health insurance increases by a million plus each year. An editorial in The Wall Street Journal hopes to redirect the focus on one of the main reasons - the federal and state government mandates that make health insurance so expensive. The National Association of Manufacturers warned that such mandates could force some employers to drop their health insurance benefits - which is exactly what’s happening. The proportion of Americans who get health insurance through their employer fell for the first time in a decade. Although there are very few federal health mandates, over the past four decades state legislatures have passed more than 1500, requiring that insurers cover everything from infertility treatments to wigs for cancer patients. Together with procedural mandates such as “community rating” (insurers can’t price based on differing risk factors such as age) and “guaranteed issue” (you can wait until you’re sick to buy insurance), they are largely responsible for the vast disparities in the cost of health insurance among the states. The WSJ lists 30 mandates in New York that make policies seven times more expensive there than a few miles away in Greenwich, Connecticut. A study by PriceWaterhouseCoopers indicates that mandates were responsible for 15 percent of the $67 billion increase in health spending in 2001. The Health Insurance Association of America estimates that mandates are the reason one in four uninsured Americans lacks coverage. The WSJ concludes that the real scandal in American health insurance isn’t that some people lack coverage for this or that treatment, but that tens of millions of Americans risk financial ruin because of policies that make basic insurance difficult or impossible to buy.
2. Health Care Report Cards May Fail Patients. Why
Risk Doing More Harm?
Health care quality report cards - such as New York’s list of physician and hospital coronary artery bypass graft (CABG) surgery mortality rates - have been the focus of an extensive policy debate. Supporters of report cards argue that they enable patients to identify the best doctors and hospitals, while simultaneously giving providers of care incentives to improve quality. Skeptics counter that report cards may give providers incentives to decline treatment to more difficult, severely ill patients in order to improve their ranking. Whether these report cards are good for patients and society depends on whether their financial and health benefits outweigh their costs in terms of the quantity, quality and appropriateness of the medical treatment they induce.
In “Is More Information Better? The Effects of 'Report Cards' on Health Care Providers” (National Bureau of Economic Research Working Paper No. 8697), authors David Dranove, Daniel Kessler, Mark McClellan and Mark Satterthwaite examine the consequences of the CABG report cards adopted by New York and Pennsylvania in the early 1990s. They find evidence that report cards had both beneficial and harmful effects. On one hand, report cards increased the number of sicker cardiac patients being treated at teaching hospitals that may be better equipped to handle such complex cases. On the other hand, report cards led providers of medical care to shift surgical treatment for cardiac illness toward healthier and away from sicker patients. On net, though, report cards led to higher levels of resource use and worse health outcomes, especially for sicker patients. Read the whole NBER report at http://www.nber.org/digest/jan02/jan02.pdf. What seems to be overlooked is that if every patient had a personal physician to help navigate the health care maze, the “report card” on consultants known by these personal physicians would probably be more accurate than any bureaucracy could devise. The hidden bureaucratic agenda and perverse incentives can never be accurately analyzed or quantified. Why risk harming patients?
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3. One Answer to the Uninsured by Alieta and John
Last week we heard from Dr Eck regarding Charity (http://www.healthplanusa.net/AE-AreYouReallyInsured.htm) and Dr Cosman defining Altruism (http://www.healthplanusa.net/MPCosman.htm) and the difference between the two. We invited Drs John and Alieta Eck to share with us their freedom and charity practice. Dr Alieta writes: We practice in two locations - My husband and I started a practice fourteen years ago, and now work with two other physicians. We avoid all the HMO's, but are still enrolled in Medicare - for now. We understand that the Medicare recipients have no choice, thus are not acting quickly to opt out of the Medicare program. We also understand the pitfalls of the huge government program, and will drop out when we know it is time. This is the practice where we earn our living, and we are meeting our payroll, paying our bills and seeing a profit that we can live on. We have two full time employees and five part-timers, all very loyal and committed to their work.
Our second practice is a 501(c)3 charity - run completely by volunteers. It is only six months old. There we see the uninsured and those with very little means to purchase any medical care. We see people who live literally hand to mouth - afraid to take off from their minimum wage job for fear that they will not be able to pay the rent. When we recommended Afrin nasal spray, one patient opened his wallet to reveal one five-dollar bill. It was Afrin or lunch.
No one draws any income from this practice, called the Zarephath Health Center (www.zhcenter.org). It is situated on the property of a church and the rent is extremely low. Our overhead is only $500 per month, paid for by donations and an occasional $20 from the patients. It is here that we can fulfill the mandate of the Good Samaritan, seeing a need, and using our own means to meet it. Donors support our work, and new volunteers are eager to help. As it grows we will be finding new physicians to volunteer. We are working to effect legislation that will minimize our malpractice liability at the ZHCenter so that we can use the 15,000 retired physicians residing in our state. Alieta and John Eck, MD
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4. Can Private Medicine and Socialized Medicine
When Adolph Hitler rose to power, there was a precedent of social welfare and government health insurance from the reign of Kaiser Wilhelm II and the administration of Chancellor Otto von Bismarck. He saw that a social insurance system could be used for Nazi politics as a bastion of bureaucratic power; as an instrument of regimentation, and as a reservoir from which to draw jobs for political favorites. Richard Ebeling, PhD, Professor at Hillsdale who recently became president of the Foundation for Economic Education, states that students will eventually look back on the two great movements of the twentieth century, fascism and communism, and wonder how was it possible that two movements that seemed so implausible should have not only attracted millions of enthusiastic followers, but, on the basis of what they considered high principle, sent millions of people to anguishing deaths? And students of the next century will look back at the current era and be equally puzzled by the fact that the dangers and problems of the welfare state had been clearly understood and again went unheeded in the late twentieth and early twenty-first century.
Why is socialized medicine so ruthless in destroying patients choice for private care? And from the letters we receive, why are so many members of society so unaware of this vendetta against the sick obtaining and paying for private care? In the United States, patients on Medicare are not allowed to pay for private care, even if they feel their disease is inadequately covered. In Canada, Jacques Chaoulli, MD, came across a patient who was placed on a long waiting list unable to obtain timely surgery to relieve his suffering because it was not covered by their Medicare. The patient sought to contract privately to cure his condition. At that time he found out that such care is strictly illegal and both patients and physicians can be prosecuted for entering into a private agreement. He also found that it is illegal to sell or buy private insurance in Canada to cover medical costs for treatments included in Medicare. He has appealed this ruling to the Canadian Supreme Court. (Read the report by Edwin Coffey, MD, at http://www.iedm.org/library/art137_en.html) The case will have tremendous significance for both Canada and the United States. He feels that physicians are indentured servants, a role inconsistent with their constitution, as well as ours. This is probably the most important legal battle in either country, “Can Medicare or Socialized Medicine coexist with private medicine?” Not if Dr Chaoulli loses this battle on behalf of our patients. It will truly be the ultimate political tragedy if a free society can implement this control over human life. It took totalitarians like Hitler and Stalin, who are not known for their benevolence to the health of human beings, to previously implement this type of control. For more on Canadian HealthCare Reforms, see http://www.iedm.org/etudes/santejuridique_en.pdf
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5. Medical Gluttony or Excessive HealthCare Costs
The medical history and physical examination gives diagnostic clues and, in many cases, the entire diagnosis. However, some patients have difficulty accepting simple solutions. This week, I saw three patients in whom I could pin point the cause of their pain. Yet each one felt they needed more tests. “If it were that simple, why did I have to come in to see you?” Precisely the point.
Mary, a 78-year-old lady, had been working in her garden and subsequently experienced some chest pain, especially when she took a deep breath. She was worried about pleurisy and heart problems. The patient had a negative heart and lung exam; however, her musculoskeletal exam gave the entire story. She was tender over her right pectoral and trapezius muscles, those large muscles that operate the shoulder and neck. I could reproduce the pain on palpation of these muscles. I diagnosed “myositis” (inflammation of muscles) which should be relieved by routine analgesics. I gave her two extra strength Tylenol, because in my clinical experience most patients will not consider something so simple as being important enough to take. When I called her later, she reported that her pain was relieved even before she got home. She was dumbfounded. However, she was still unconvinced of my diagnosis and wasn’t sure if she would repeat the recommended dosage. I assured her that the pain would return and that she should take that dose three times a day until the pain was totally resolved. She still questioned whether we should have gotten a CT of her chest.
Two additional patients with similar musculoskeletal pains in other groups of muscles that could clearly be localized and duplicated responded with the same questions, had the same immediate result, but continued to wonder why they were not getting cardiac consultations. The fact that certain muscles received a work out with spring gardening and house cleaning did not seem to register.
Americans seem to have a blinding faith in high tech diagnoses and have great difficulty accepting simple solutions to medical problems. In all three cases, there would have been at least a ten-fold (1000 percent) increase in costs over a simple office call to proceed with high tech diagnostics, which would have neither verified myositis nor improved health care outcome. Only patient responsibility for a significant percentage copayment would resulted in a knowledgeable understanding of the medical issues. Costs would then have automatically fallen into place.
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6. Overheard in a Medical Staff Lounge From Dr
I thought my best educated patients would be the most cost effective. However, they come in with reams of internet reprints demanding dozens of tests in order to exclude diseases for which there is no clinical indication. Just give me a dumb patient. “Doc, my right hand and leg don’t work anymore. Is there something you can do about that?”
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• John and Alieta Eck, MDs. We congratulate and welcome John and Alieta Eck, MDs, for their first-century approach to twenty-first century problems. Please visit with them at www.zhcenter.org.
• Madeleine Pelner Cosman, JD, PhD, Esq. We recognize Dr Madeleine Cosman for her important efforts in restoring accountability in health care. Please visit http://www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government’s efforts in criminalizing medicine, the introduction to her new book, Who Owns your Body, and other articles that are important to the practice of medicine and health care in general.
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. We recognized Dr David Gibson for his contributions to the free Medical MarketPlace. His series of articles in Sacramento Medicine can be found at http://www.ssvms.org and additional articles such as Health Care Inflation at http://www.healthplanusa.net/DGHealthCareInflation.htm.
• Dr Richard B Willner, President, Center Peer Review Justice Inc, reports his latest success story and the secret of helping doctors keep their medical license. On a daily basis, doctors are reviewed, are suspended, lose their medical licenses and go to jail on trumped-up charges. These "Extra"-legal services are necessary services that your lawyer does not offer. Stay posted with a wealth of information at http://www.peerreview.org. “The Center for Peer Review Justice now has a Joint Venture Partner so we can offer Headhunting for those MDs who have been DataBanked and can not find a new job. Our partner is a firm of some 20 years of experience. This is a fee based service where the fee is paid by both the doctor and facility.”
• PATMOS EmergiClinic - where Robert
Berry, MD, an emergency physician and internist, provides prompt care for
many of the injuries and illnesses treated in Emergency Rooms at a fraction of
the usual emergency room fees. For a listing of his fees and payment policy, see
www.emergiclinic.com. Read Dr
Berry’s response to Physician’s Support of Single-Payer Health Care or
Socialism as well as other articles at http://www.delmeyer.net/hmc2004.htm#by%20Robert%20Berry.
• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), www.sepp.net, for making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing. Several free newsletters are available. This month read articles by Edward Annis on American Medicine and by Ian Bogle on British Medicine. Be part of protecting and preserving what is right with American Healthcare - physicians, nurses, pharmacists, psychologists, all health professionals and all concerned individuals are urged to join.
• Dr Vern Cherewatenko for success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, www.simplecare.com. Any patient or provider may become a member of SimpleCare. There is a section on Functional Medicine and one on Complementary and Alternative Medicine, a practice that is becoming increasingly popular.
• Dr David MacDonald started Liberty Health Group, www.LibertyHealthGroup.com, to assist physicians in controlling their own medical benefit costs for their staff and patients. There is extensive data available for your study. He is available to speak to your group on a consultative basis.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column that is now at NewsMax. Please log on to read or subscribe at http://www.newsmax.com/pundits/Medicine_Men.shtml. This week’s column is on “Bush vs. Kerry and Your Health Choices” and can be found at http://www.newsmax.com/archives/articles/2004/3/16/161803.shtml.
• The Association of American Physicians & Surgeons (www.AAPSonline.org). The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down to departments and The “AAPS News,” written by Jane Orient, MD, and archived on this site, providing valuable information on a monthly basis. Scroll further to their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, and the Editor-in-Chief. This month we direct your attention to the correspondence section with Jacques Chaoulli, MD, of Montreal, Quebec, reporting on his precedent-setting law suit on behalf of patients in the interest of freedom in medicine, at great personal risk. The lawsuit has already cost him about $600,000. Moreover, in Canada the loser is usually forced to pay the government’s cost. Dr Chaoulli can be contacted at firstname.lastname@example.org. Dr Huntoon states that Dr Chaoulli is a very courageous doctor who deserves our praise and support and that he is literally risking everything in this bid for freedom in Canada. The AAPS website is a cyberspace library for books of interest, brochures, the journal, as well as congressional testimonies, fraud, economics, action alerts and health care news. It’s worth spending an hour a week on each MedicalTuesday, even those in which you don’t receive this newsletter, to review and keep apprised of items of medical and health care interest. The life you may become interested in saving could be your own. This month, Dr Huntoon suggests we take a look at an article by Steve Twedt, in the Pittsburgh Post-Gazette, “‘Disruptive' doctors an issue in California” which can be found at http://www.post-gazette.com/pg/04078/287560.stm.
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Stay Tuned to the MedicalTuesday.Network and Have
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See some recent postings below.
Del Meyer, MD, CEO & Founder
"If you think health care is expensive now, wait until you see what it costs when it's free." -P.J.
Charles B Clark, MD: A Piece of the Pie: What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn’t anything left for them, are we going to tell them we didn’t fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them it’s all right because we got a piece of the pie? http://www.healthcarecom.net/CBCPieceofPie.htm
Ada P Kahn, PhD: Foreword to "Encyclopedia of Work-Related Injuries, Illnesses and Health Issues. Dr Kahn came to Sacramento last month and I joined her on a Channel 31 interview about her book. I was privileged to write the foreword which we’ve posted at http://www.delmeyer.net/MedInfo2004.htm To purchase the book, go to http://www.factsonfile.com/ and type in KAHN under search.
Tammy Bruce: The Death of Right and Wrong
(Understanding the difference between the right and the left on our culture and
Reviewed by Courtney Rosenbladt.